2010 UBO/UBU Conference

Title: Optometry & Ophthalmology Coding
Session: T-3-1630

Overview





Visual Field Testing
Color Vision Testing
Sensorimotor Testing
Corneal Topography
Ocular Photography
Extended Ophthalmoscopy

2

Visual Fields
http://www.bing.com/images/search?q=limited+visual+field+exam+findings&view=detail&id=483D63
B4437D7B634D33A3A3E9AD6035B694250F&first=1&FORM=IDFRIR
1/27/11

3

Visual Fields – Potential Diagnoses

ICD-9







368.40: Visual field defect,
unspecified
368.41: Scotoma involving
central area
368.42: Scotoma of blind spot
area
368.43: Sector of arcuate
defects
368.44: Other localized visual
field defect
368.45: Generalized
contraction or constriction
368.46: Homonymous bilateral
field defects
368.47: Heteronymous
bilateral field defects

ICD-10






H53.40 Unspecified visual field
defects
H53.411- H53.419: Scotoma
involving central area
H53.421 – H53.429: Scotoma
of blind spot area
H53.431 – H53.439: Sector or
arcuate defects
H53.451 – H53.459: Other
localized visual field defect
H53.461 – H53.469:
Homonymous bilateral field
defects
H53.47: Heteronymous bilateral
field defects
H53.481 – H53.489:
Generalized contraction of
visual field
4

7th edition.com/isopter 1/27/11 5 .Visual Field Terminology  Perimetry: A test in which a topographic ‘map’ is created of the visual field. it is the contour line representing the limits of equal retinal sensitivity to a given test target – Millodot: Dictionary of Optometry and Visual Science.. and neuroophthalmic Goldmann perimetry.com/perimetry 1/27/11 Millodot: Dictionary of Optometry and Visual Science.com/perimetry 1/27/11 Isopter: In the determination of visual fields. © 2009 Butterworth-Heinemann. uses both stationary– static light sources of increasing intensity and moving light sources to delineate the visual field.thefreedictionary. defects of which can be either central or peripheral –  Static perimetry: Measurement of the visual field with a target that can be varied in dimension and luminance. retina. Inc. The target can be presented in any part of the visual field –  McGraw-Hill Concise Dictionary of Modern Medicine. 7th edition.thefreedictionary. © 2009 Butterworth-Heinemann. to diagnose and evaluate diseases of optic nerve. http://medical-dictionary. © 2002 by The McGraw-Hill Companies.thefreedictionary. http://medical-dictionary. http://medical-dictionary.

arc perimeter. tangent screen. with interpretation and report. unilateral or bilateral.Limited Visual Field Exam 92081: Visual field examination. such as Octopus 3 or 7 equivalent) 6 .g. or single stimulus level automated test. limited examination (e.. Autoplot.

Tangent Screen Visual Field 7 .

edu/ips/Perim etryHistory/3-perimeter.gif 1/28/11 8 .com/images/Octo pus%20visual%20field.uiowa.ophth.hudsoneyemd.htm 1/27/11 http://www.Limited Visual Field Image Source Page: http://webeye.

with interpretation and report.. at least 2 isopters on Goldmann perimeter. unilateral or bilateral. automated suprathreshold screening program. Octopus program 33) 9 .Intermediate Visual Field Exam 92082: Visual field examination. intermediate examination (e. or semiquantitative. Humphrey suprathreshold automatic diagnostic test.g.

Intermediate Visual Field http://www.glaucoma-eye-info.com/images/Perimeter-chart.gif 1/28/11 10 .

extended examination (e. 24-2. Octopus program G-1.Extended Visual Field Exam 92083: Visual field examination. with at least 3 isopters plotted and static determination within the central 30 degrees. or 42. or quantitative. with interpretation and report. 32.g. Humphrey visual field analyzer full threshold programs 302. unilateral or bilateral.. automated threshold perimetry. or 30/60-2) 11 .

scielo.br/scielo.ed.uk/courses/VI&multi/vnov0 72i.education.ssc.html Image Source Page: http://www.php?script=sci_arttext&pid=s1807-5932200600050 0018 12 .Goldmann Visual Field Image Source Page: http://www. ac.

aspx?Id=70D70AD0-26BE-4F 51-B5AC-D58DE76B081A 13 .ammayieyehospital.au/Content_C ommon/index.com.Humphrey Visual Field Image Source Page: http://www.eyes2sea.html Image Source Page: http://www.com/specia l-eye-care-facilities.

3.Documenting Visual Field Exams  5.1. Documentation must include a descriptive summary. including noteworthy findings. Simply clicking the procedure in AHLTA is not adequate documentation to support coding of a procedure. What would be appropriate documentation? – – Copy of visual field report from device Provider’s interpretation of device report/printout in AHLTA. Documentation Requirements for All Procedural Interpretation and Report – –  Although the interpretation does not have to be a separate page. the summary of the findings must contain sufficient detail that a conclusion of the significance of the findings can be made. changes from prior visual field exam 14 . reliability of test.

superstock.2/1/11 Color Vision 15 .http://www.com/stock-photos-images/1597.

55: Tritanomaly H53.52: Deutan Defect 368.54: Protanomaly H53.59: Other color vision deficiencies  ICD-10 – – – – – – – H53.Color Vision – Potential Diagnoses  ICD-9 – – – – – – 368.51: Achromatopsia H53.50: Unspecified color vision deficiencies (Color blindness NOS) H53.59: Other color vision deficiencies 16 .53: Deuteranomaly H53.53: Tritan Defect 368.54: Achromatopsia 368.52: Acquired color vision deficiency H53.51: Protan Defect 368.55: Acquired color vision deficiencies 368.

. extended. vision under glare) – This service must employ graduated visual acuity stimuli that allow a quantitative determination of visual acuity (e. and field of vision (may include all or some screening of the determination(s) for contrast sensitivity. Snellen chart).g. This service may not be used in addition to a general ophthalmological service or an E/M service 17 . It is included in the appropriate general or ophthalmological service. e. 99172: Visual function screening. automated or semiautomated bilateral quantitative determination of visual acuity. ocular alignment..Color Vision Testing  92283: Color vision examination. anomaloscope or equivalent –  Color vision testing with pseudoisochromatic plates (such as HRR or Ishihara) is not reported separately. color vision by pseudoisochromatic plates.g. or 99172.

robinsonscamera.edu/nursing/simlab/html/picture/index.Color Vision Testing Image Source Page: http://www.htm 1/27/11 Image Source Page: http://www.h tml 1/27/11 Ishihara (PIP) Test Image Source Page: http://www.co m/color_blindness_test.html 1/27/11 18 .caleyecare.utexas.org/visionfunctions.

es/webvision/kallcolor.edu/KallCol or.e-mfp.html Image Source Page: http://retina.html Image Source Page: http://www.org/2008v3n2/Ethambut ol_ocular_toxicity2.umh.med.utah.html Image Source Page: http://www.com/products/126/ 19 .Color Vision Testing Image Source Page: http://webvision.imbotec.

colourmed.html 20 .com/tests.Color Vision Testing – Anomaloscope Image Source Page: http://www.

FM-100: Should include scoring sheets and provider documents interpretation of findings – Anomaloscope: Notation of findings and provider’s interpretation 21 .Color Vision Testing  Documenting results: – Ishihara: # missed over # tested (14) – FALANT: Pass/Fail – D15.

http://www.co.htm 2/1/11 Sensorimotor Testing 22 .optomshop.uk/stereo_fly_test.

00: Amblyopia.33: Fusion with defective stereopsis 368.02: Deprivation amblyopia 368.5x: Paralytic strabismus 378.34: Abnormal retinal correspondence 378.2: Diplopia 368. unspecified 368.30: Binocular vision disorder.53: Spasm of accommodation 368.6x: Mechanical Strabismus 378.7x: Other specified strabismus 378.32: Simultaneous visual perception without fusion 368.3x: Other/unspecified heterotropia 378.51: Paresis of accommodation 367.9: Unspecified disorder of eye movements 23 .Sensorimotor Testing – Potential Diagnoses  ICD-9 – – – – – – – – – – – – – – – – – – – – – – 367.4x: Heterophoria 378.2x: Intermittent heterotropia 378.52: Total or complete internal ophthalmoplegia 367.0x: Esotropia 378.01: Strabismic amblyopia 368.1x: Exotropia 378.31: Suppression of binocular vision 368.8x: Other disorders of binocular eye movements 378. unspecified 368.

Sensorimotor Testing – Potential Diagnoses  ICD-10 – – – – – – – – – – – – – – – – – H50.5xx: Heterophoria H50.1xxx: Exotropia H50.0: Palsy of conjugate gaze H51.8xxx: Other specified strabismus H50.3x: Other and unspecified disorders of binocular vision 24 .6xxx: Mechanical strabismus H50.0xx: Amblyopia H53.9: Unspecified strabismus H51.0xxx: Esotropia H50.1x: Convergence insufficiency & excess H51.2x: Vertical strabismus H50.9: Unspecified disorder of binocular movement H53.2: Diplopia H53.2x: Internuclear ophthalmoplegia H51.8: Other specified disorders of binocular movement H51.4xxx: Other & unspecified heterotropia H50.3xxx: Intermittent heterotropia H50.

down. restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure) A good definition for sensorimotor testing: – “multiple measurements of ocular deviations with interpretation and report. left and right gaze) and inclusion of at least one appropriate sensory test in patients who are able to respond (Randot or Titmus test)”  http://www.org/ophthalmology-pearls/2009/09/cpt-code-92060-sensorimotor -examination. up.Sensorimotor Testing   92060: Sensorimotor examination with multiple measurements of ocular deviation (e.. It includes measurement of ocular alignment in more than one field of gaze at distance and/or near (primary.html 1/27/11 25 .medrounds.g.

com/ccp7/Stereo-Fly-AcuityTest Image Source Page: http://www.com/main/node/242 38 26 .h azblog.Sensorimotor Testing Image Source Page: http://oftall-articulos.hakeem-s y.guldenophthalmics .com/Articulos-b1/A rticulosImage Source Page: http://www.

html 1/27/11 Image Source Page: http://www.uab.html 1/27/11 27 .edu/alj1013/O cularMotility.mrcophth.cis.com/finalmrcophthm cqss/41.Sensorimotor Testing Image Source Page: http://students.

Sensorimotor Testing  Documenting sensorimotor testing – Randot _/10 – Maddox 10 RH’ – “Tic-tac-toe" format representing different fields of gaze – Number of rings or wings on Titmus test correctly observed – Worth 4 dot – which lights were observed – Cover/uncover test results 28 .

rochester.edu/eye-institute/lasik/technology/orbscan-corneal-topographer.cfm 1/27/11 Corneal Topography 29 .urmc.Image Source Page: http://www.

with interpretation and report – (Do not report 92025 in conjunction with 65710 – 65771) – (92025 is not used for manual keratoscopy. unilateral or bilateral.Corneal Topography   92025: Computerized corneal topography. which is part of a single system Evaluation and Management or ophthalmological service) Documentation Tips: – Computerized printout – Provider’s findings/interpretation of printout – Test reliability 30 .

6x: Keratoconus 371.2xx: Other & unspecified corneal edema H18.6xx: Keratoconus H18.4xx: Corneal degeneration H18.2x: Corneal edema 371.8x: Other corneal disorders  ICD-10 – – – – – – – – H18.5xx: Hereditary corneal dystrophies H18.7xx: Other and unspecified corneal deformities H18.3x: Changes of corneal membranes 371.8xx: Other specified disorders of cornea 31 .3xx: Changes of corneal membranes H18.1x: Bullous keratopathy H18.Corneal Topography – Potential Diagnoses  ICD-9 – – – – – – – – 370.4x: Corneal degenerations 371.7x: Other corneal deformities 371.0x: Corneal Ulcer 371.5x: Hereditary corneal dystrophies 371.

org/Keratoconus 1/27/11 Image Source Page: http://www.Corneal Topography Image Source Page: http://eyewiki.com/view.asp?rid=17873 1/27/11 32 .osnsupersite.aao.

org/OpPhoto/Extern/Motility/Motility2.opsweb.html 2/1/11 Ocular Photography 33 .http://www.

close-up photography. changes from previous exam. 34 .Ocular Photography  Codes: – – –  92250: Fundus photography with interpretation and report 92285: External ocular photography with interpretation and report for documentation of medical progress (e. stereophotography) 92286: Special anterior segment photography with interpretation and report. etc.. slit lamp photography. goniophotography. with specular endothelial microscopy and cell count Documenting interpretation/report – – Photos included Noteworthy findings.g.

medscape.uiowa.edu/wctb/coms/p atient/photog/fundus1a.cuttingedgecnc .com/Default.ophth.jhu.edu/eyef orum/tutorials/photog Image Source Page: http://www.aspx?blogentryid=33 35 .com/digcam-mt.htm Image Source Page: http://drsobol.Ocular Photography Image Source Page: http://webeye.htm Image Source Page: http://emedicine.co m/article/1228681-overview Image Source Page: http://www.

com/images/search? q=Extended+ophthalmoscopy&view=detail&id=113F006C37D09B0BE513A1E73C355E10C0211091&first=1&FORM=ID FRIR 1/27/11 Extended Ophthalmoscopy 36 .bing.http://www.

extended. with retinal drawing (e. with interpretation and report. subsequent 37 . melanoma).g.. extended. for retinal detachment. with interpretation and report.g. initial 99226: Ophthalmoscopy.Extended Ophthalmoscopy   92225: Ophthalmoscopy.. for retinal detachment. melanoma). with retinal drawing (e.

hemorrhages. A serious retinal condition must exist or be suspected.12. These codes are reserved for the meticulous evaluation of the eye and detailed documentation of a severe ophthalmologic problem when photography is not adequate or appropriate 6. Ophthalmoscopy –  Extended (92225) and subsequent (92226) ophthalmoscopy are considered reasonable and necessary services for evaluation of tumors of the retina and choroid (the tumor may be too peripheral for an accurate photograph).8. retinal tears. detachments.1.2. which requires further detailed study 38 . based on routine ophthalmoscopy.Extended Ophthalmoscopy  6. of course. Frequency of Service – Frequency for providing these services depends on the medical necessity of each patient and this.8. as well as other ocular defects when the patient’s medical record meets the documentation requirements set forth in this policy. exudative detachments. relates to the diagnosis.12. and retinal defects without detachment.

3. It must add information not available from the standard evaluation services or information that will demonstrably affect the treatment plan.8. extended ophthalmoscopy must be medically necessary. to confirm information already available by other means 39 . for example.Extended Ophthalmoscopy  6. It is not medically necessary.12. Medical Necessity – In all instances.

must be submitted with each encounter 40 . including a three-dimensional representation or an extended colored retinal drawing.12. The documentation of follow-up services (92226) must include an assessment of the change from previous examinations  Documentation supporting the medical necessity of this item.8. which requires further study. such as ICD-9 codes. Major Criteria – These criteria must be met:  A serious retinal condition is present based on ophthalmoscopy. a retinal tear detachment. Sketches and templates are not acceptable.Extended Ophthalmoscopy  6. for example 360º scleral depressions. such as the detailed study of pre-retinal membrane. a suspected retinal tear with sudden onset of symptomatic floaters or vitreous hemorrhage  Another diagnostic technique in addition to routine direct and indirect ophthalmoscopy is necessary and documented.4. or 90-diopter lens  The technique and findings of the extended ophthalmoscopy must be documented. fundus contact lens.

bing.com/images/s earch? q=retinal+detachment&qpvt=r etinal+detachment&FORM=Z 7FD2 1/27/11 http://www.Extended Ophthalmoscopy http://www.com/images/search? q=retinal+melanoma&view=detail&id=3348FCFEF8E58213ECC 22D72FF8653EB07D19633&first=1&FORM=IDFRIR 1/27/11 41 .bing.

Extended Ophthalmoscopy http://thm-a01.com/nimage/3c1a96da9d8a00a2 1/27/11 42 .yimg.

it wasn’t done.Reminder… “If it’s not documented.” NOT CODEABLE Questions??? 43 .

References     CPT® 2011 Professional Edition. ICD-10 MHS Coding Guidelines. American Medical Association ICD-9. 2011 44 .